# Incident Report Form Template

> A free incident report form for workplace accidents, injuries, and near misses. Staff report from their phone, with photos, while details are fresh.

Record what happened, when and where, who was involved or injured, and what was done next. Use it as a ready incident report form sample, or add questions for your workplace.

Canonical: https://reuily.com/templates/incident-report-form
Use this template: https://reuily.com/form/from-template/incident-report-form
Collections: Requests & Intake, Human Resources, Operations
Last updated: 2026-10-06

## Questions

- Question 1: What's your name? (Short Text, required)
- Question 2: What's your email address? (Email, required)
- Question 3: What type of incident was it? (Single Choice, required). Options: Injury; Near miss; Property damage; Security; Other
- Question 4: When did it happen? (Date, required)
- Question 5: What time did it happen? (Time, optional)
- Question 6: Where did it happen? (Short Text, required)
- Question 7: What happened? (Long Text, required)
- Question 8: Was anyone injured? (Yes / No, required)
- Question 9: Who was involved or saw it happen? (Long Text, optional)
- Question 10: What was done right after? (Long Text, optional)
- Question 11: Add photos of the scene (File, optional)
- Question 12: Sign to confirm this report is accurate (Signature, required)

Signing records the signer's consent, email, IP address, browser and signing time, and each signer can download a signed PDF copy.

## Common uses

- Workplace injuries and accidents
- Near misses and safety hazards
- Property damage and security incidents

## Key features

- Photo uploads
- Signed and time stamped
- Witness details

## Frequently asked questions

### What should an incident report include?

What happened, the date, time, and place, who was involved or injured, any witnesses, and what was done straight after. This form asks for each of these in order.

### Can staff add photos to an incident report?

Yes. Staff can add photos from their phone camera or files. Each report is signed and saved with the time it was submitted.

### Can I use this incident report form sample as it is?

Yes. It covers injuries, near misses, property damage, and security incidents. Check whether your industry or regulator needs extra details, such as OSHA recordkeeping, and add them.